Page 139 - 2022 Ranger Medic Handbook

Laceration
DEFINITION: Laceration
S/Sx: Simple uncomplicated laceration of skin without involvement of deeper structures.
MANAGEMENT:
1. Irrigate and clean wound thoroughly.
2. Prepare area in sterile fashion.
3. Provide local anesthesia with 1% lidocaine with or without epinephrine depending on site.
4. Close with absorbable suture, nonabsorbable suture, Dermabond, or Steri-Strips as dependent on depth of wound.
5. If dirty wound or environment, antibiotics should be considered.
6. Check tetanus status and treat as needed; do not suture if wound is > 12 hold (> 24 hours on face), or if puncture/
bite wound.
7. Nonabsorbable sutures should be removed in 7–10 days. Most animal bites should not be closed with suture, consult SECTION 3
a provider on when to close lacerations from animal bites. After sutures, place a dressing with antibiotic cream and
do not soak in water while sutures are in place, keep dry for 24–48 hours.
DISPOSITION: Evacuation usually not required.

Loss of Consciousness (without Seizures) / Syncope
DEFINITION: The most common cause of loss of consciousness in healthy adults is orthostatic hypotension (associ-
ated with sudden standing) or vasovagal syncope (associated with sudden adverse stimulus – injections are a common
cause).
S/Sx: Unconsciousness
MANAGEMENT:
1. If no respirations or pulse, follow BLS guidelines. If associated with trauma (blast, fall, MVA, etc.) in last 14 days, then
manage per mTBI Protocol.
2. Management of orthostatic hypotension and vasovagal syncope is accomplished by placing the patient in a supine
position, ensuring the airway is open. Patients experiencing these two disorders should regain consciousness within
a few seconds. If they don’t, consider other etiologies and proceed to the steps below.
3. Place either 1 tube oral glucose gel or contents of one packet of sugar in buccal mucosal region (DO NOT use oral
glucose if patient remains unconscious).
4. Gain IV access.
5. Naloxone 2mg IV/IM. Repeat q2–3min prn to max dose of 10mg.
6. If no response, treat per appropriate protocol per Special Considerations.
7. Pulse oximetry monitoring.
8. Oxygen if available.
DISPOSITION: Urgent evacuation, unless loss of consciousness clearly due to orthostatic hypotension or vasovagal
hypotension. The evacuation package should include personnel certified in Advanced Cardiac Life Support (ACLS), with
equipment, supplies and medications necessary for ACLS care.
SPECIAL CONSIDERATIONS: Also consider hypoglycemia, anaphylactic reaction, medication, recreational drug use,
head trauma, hyperthermia, hypothermia, myocardial infarction, lightning strikes, and intracranial bleeding. Obtain ECG
if able in all undifferentiated syncope patients.

2022 RANGER MEDIC HANDBOOK 125